Provider Demographics
NPI:1770277741
Name:JERRILS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JERRILS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 N 750 W
Mailing Address - Street 2:
Mailing Address - City:FRANKTON
Mailing Address - State:IN
Mailing Address - Zip Code:46044-9469
Mailing Address - Country:US
Mailing Address - Phone:317-525-5619
Mailing Address - Fax:
Practice Address - Street 1:7640 N 750 W
Practice Address - Street 2:
Practice Address - City:FRANKTON
Practice Address - State:IN
Practice Address - Zip Code:46044-9469
Practice Address - Country:US
Practice Address - Phone:317-525-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula